Homeopathy – so diluted there’s no evidence left.

I woke up this morning to my usual radio station to hear a discussion about the pros and cons of homeopathy. There was the President of the AMA being careful to say that homeopathy is "implausible" (he probably wanted to say "impossible" and "ridiculous", but was being polite) and the obligatory phone callers who had had marvelous results from using magic water.

This was the result of an internal document from the National Health And Medical Research Council that had somehow fallen into the hands of a journalist. The draft statement from the NH&MRC suggested that it was "unethical for health practitioners to treat patients using homeopathy, for the reason that homeopathy (as a medicine or procedure) has been shown not to be efficacious".

This seems perfectly reasonable. Doctors should not be telling patients to take medicines unless those medicines have been demonstrated to have some effect on whatever medical condition the patient might have. This is in line with recommendations such as not prescribing antibiotics for viral infections and not prescribing certain psychiatric medications without some investigation of the underlying cause of the apparent illness.

The difference is that antibiotics and antidepressants work when applied in the appropriate situations. Homeopathy not only does not work ("not to be efficacious") but simply cannot work. It is not only scientifically implausible, it is scientifically impossible.

Let’s look at a couple of the fundamental principles of homeopathy. (And, contrary to the radio caller this morning who said that homeopathy is 5,000 years old, it was invented in the 18th century.)

The first principle discovered by Samuel Hahnemann, the inventor of homeopathy, is "Like cures like". What this means is that the cure for some (any?) condition will be something that produces the symptoms of the disease if given in large enough quantities. So, for example, if house dust causes hay fever then the contents of your vacuum cleaner bag should be able to be used to prevent sneezing and watery eyes, or if nettles cause your skin to become red and itchy then nettles are a possible treatment for sunburn. A special note is needed here for people who think that you can just go to the chemist or health food shop and buy ready-made homeopathy – each patient should be treated as an individual, with an individually-prepared treatment. What works for some people might not work for others.

Obviously too much of a good thing can be harmful, so Hahnemann came up with a second principle – "The Law Of Infinitesimals" – which states that the smaller the dose the greater the effect. That’s what the "30C" and other numbers on bottles of homeopathic medicines mean – the amount of dilution that has gone on. Taking 30C as an example, this means that one part of the "mother tincture" has been diluted with 99 parts of water (or sometimes alcohol). The resulting mixture is then shaken in a special way (called "succussion") and 1% is taken out and mixed with 99 parts of water. We now have 2C, so the process has to be repeated 28 more times. The final result is something with no active ingredient in it at all.

The number I really like is 40C. At this level of dilution the bottle of homeopathy would have to contain all the atoms in the universe to guarantee a single atom of the original material.

Dilutions beyond this are common, and I often see 200C on packets and bottles. To anyone with a smattering of science, Avogadro’s Number means that anything beyond 12C is almost certain to contain no active ingredients, and this has been known since almost the same time as homeopathy was invented. So how do homeopaths account for the supposed action of things with no active ingredients. Simple – they have invented the "memory of water". Apparently water remembers the things it has been in contact with even after those things have gone away, although this process must be selective because otherwise it would remember being a component of urine, vomit and other distasteful things in the past. Homeopaths don’t have an explanation for this selective memory, but why should they when it’s all magic anyway.

You might be asking how this memory of water thing has anything to do with homeopathic pills. Well, those are made by dripping water onto sugar pills and then letting them dry out. Somehow the memory of water becomes the memory of lactose. This all makes sense, doesn’t it?

So, homeopathy is based on two principles, neither of which make sense and one of which was shown to be scientifically impossible in the early 19th century. So how does it manage to survive?

The only answer I can suggest to this is that homeopaths rely on the scientific ignorance of the general public and their willingness to believe anyone with a convincing smile. It also survives because it is given credibility by regulatory authorities such as the Therapeutic Goods Administration who have loopholes which allow products with no proven benefit to achieve a form of registration. (If you see that your medicine has a code on the package which says "AUST R" it means that it must have been shown to work before being added to the Register of Therapeutic Goods. If it says "AUST L" it just has to be relatively safe, but efficacy against any medical condition has not been demonstrated. If it has neither then the maker hasn’t even bothered to submit it to the TGA.) The TGA has just released a list of 25 "complementary medicines" that supposedly have been shown to have some efficacy. I will comment on the faults in the list later, but right now all you need to know is that there is no homeopathy in it.

Another thing providing legitimacy to homeopathy is that health funds provide refunds for it. They do this for no other reason that marketing – they think that by offering quackery as extras that they might get more customers. I’m happy to pay less for my health insurance if the insurer stops giving away money for treatments that are useless. It is also taught in universities alongside real medicine and real science, taking places and facilities from disciplines that might teach matters related to reality.

So how big a business is homeopathy. According to the Australian Association of Professional Homeopaths there are about 700 registered homeopaths in Australia, although that registration is not with any government body but is a self-regulated system. Homeopaths approve other homeopaths as professionals. The 700 sounds like a lot, but according to the Yellow Pages there are 69 astrologers and 235 psychics operating in NSW alone, and I assume these are all professionals as well. Nonsense doesn’t stop being nonsense just because practitioners club together and issue certificates.

And of course there’s money to be made. One prominent Australian homeopath sells "pillules" for fifteen cents each with various packets promising, sorry, suggesting, relief from different ailments. The pillules are indistinguishable from those hundreds-and-thousands that you use to make fairy bread for your little kids’ birthday parties, but you probably pay a lot less than $2,650 per kilogram for the cake decorations. Do you really believe that the homeopath goes through the 120 steps necessary to make a 30C solution in water and then wets individual little balls of sugar with the solution before letting them dry out so they can be packaged? Neither do I. Homeopathy sold this way is financial fraud as well as being medical fraud.

Here’s what I think should be done to manage the use of homeopathy in Australia:

Remove all homeopathic products from pharmacies

Stop teaching it in universities as if it has any scientific or medical validity. (The money saved could be transferred to the Flat Earth studies in the geography department. Oh, wait, they don’t waste time on things like that.)

Stop wasting money on research into something that has been known to be impossible for centuries.

Stop providing legitimacy by listing things that don’t work on the Register of Therapeutic Goods.

Prosecute homeopaths who claim that their treatments do any more than make people feel better about themselves.

Teach basic arithmetic in schools a so that people can understand the absurdity of infinite dilution.

I’ll use that last point to illustrate how little you need to know to see through the farce. I demonstrated making a serial dilution of ink to my 7-year-old grandson. When I got to about 10C I asked him if there was any ink in the last container. He looked at me with that look that children have when they know that adults are being particularly stupid and said in a scornful voice: "No".